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May 30, 2018

Work requirements for Medicaid reprieve for 'frail' in state

Changes are aimed largely at "able-bodied" adults

Concerned that people will lose health coverage under Kentucky Medicaid rules that take effect July 1, a nonprofit health foundation said it is joining with state government to help people understand how to keep access to health care.

"We want to try to do our best to prevent people from falling off the rolls," said Ben Chandler, president of Foundation for a Healthy Kentucky, which is spearheading the effort. "The view of the foundation and its board is that the more people covered, the better the overall health of this state."

And given the state's ongoing crisis of addiction, the foundation will focus especially on reaching the estimated one-third of Kentucky's Medicaid population that suffers from a substance use disorder. Under Medicaid rules, such individuals would be eligible for treatment.

Chandler announced the plan Wednesday at a press conference in Louisville where he was joined by Gov. Matt Bevin and officials including Adam Meier, secretary of the Cabinet for Health and Family Services, which administers Medicaid.

It comes amid concerns that rules being adopted by Kentucky and other states will cause many who don't understand the complicated requirements to lose access to health care.

The Center for Budget and Policy Priorities, a nonpartisan group that focuses on poverty and inequality, warned in a report last week that many people likely will lose coverage under the rules, including new work requirements planned in Kentucky and other states.

"Those who lose coverage will have less access to care, less financial security, and worse health outcomes," the report said.

The Bevin administration has projected about 95,000 people will lose Medicaid coverage over the five-year plan.

But Bevin has said Kentucky's Medicaid program, which covers about 1.4 million low-income or disabled Kentuckians, is too big and costly. His goal is to move more people into commercial health plans, such as those provided by employers.

The changes will be phased in over the next six months, starting in July in Northern Kentucky. Jefferson County will be added Oct.1.

The changes are aimed largely at the "able-bodied" adults among about 500,000 low-income people added to Medicaid in recent years through the Affordable Care Act, which allows states to provide Medicaid coverage to single adults below 138 percent of the federal poverty level, an annual income of about $16,400 for an individual.

Kentucky became the first state to win approval from the Trump administration in January for new "community engagement" rules that require some individuals to work, volunteer or attend school at least 20 hours a week in order to keep Medicaid coverage.

The new rules are part of a "waiver" requested by the Bevin administration that also will require some individuals to make co-pays for services and pay monthly premiums of $1 to $37.50 per month or risk being "locked out" of coverage for six months.

Many of those people affected by the changes will be exempt from work requirements, including people with disabilities or those deemed "medically frail" because of chronic health conditions. But they would still be required to seek the exemption and file documentation with the state to keep coverage.

While details are yet to be determined, Chandler said his foundation plans to launch a statewide effort to identify people who will be affected by the changes and help them comply with new rules, including finding jobs or volunteer work, if necessary.

The foundation also will seek ways to help people who can't afford monthly premium payments, he said. And it will assist with new reporting requirements people must make to show they are complying with the rules.

Chandler said the foundation will try to enlist help from community groups and seek donations to finance the work,

"Our singular goal in this project is to help ensure that as many Kentuckians as possible who are currently eligible for Medicaid are able to retain their health coverage for necessary health care," Chandler said.

He said the foundation has hired Veronica Judy Cecil, a former top Kentucky Medicaid official, as the executive director of the new program.

Cecil served as deputy director of Medicaid until January.

Cecil, he said, "has a deep knowledge of both the Kentucky Medicaid program and the waiver."

Many health advocates have been critical of Kentucky's Medicaid changes and similar plans proposed by other states as too costly and unnecessarily punitive toward low-income people. A lawsuit challenging Kentucky's plan on behalf of 16 Kentuckians who say they would be harmed by the changes is pending in U.S. District Court in Washington.

A federal judge last month refused the government's request to move the case to federal court in Kentucky, saying the case has "national consequences" that could apply "broadly across the nation."

Chandler said his foundation doesn't have a position on Bevin's Medicaid changes affecting Kentucky.

"We are a nonpartisan, nonprofit organization, and our board has not taken a position on the waiver," he said. "Our official position is that we want to see more Kentuckians with health coverage."


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